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Want to improve? Don't rely on surveys alone
Relying on patient satisfaction survey scores alone to drive your improvement efforts is probably a mistake, says Michael F. Sciarabba, MPH, CHAM, director of patient access services at Advocate Illinois Masonic Medical Center in Chicago.
"Raw scores in the registration domain, on scheduling, registration, privacy and wait times should be used as a critical measure to monitor," says Sciarabba. "But, patient access must find other ways to make improvements. Departments should be proactive and creative to impact the scores successfully."
Here are some strategies used by patient access leaders at Advocate Illinois Masonic Medical Center:
Registration hands out survey cards.
This keeps survey questions "top of mind" for staff. At the same time, it makes patients aware of the department's goals.
Results are tracked and trended, with the survey card results compared to other satisfaction survey scores. "Distributing the survey cards is especially effective in outpatient registration," says Sciarabba.
The cards use the same questions and rating scales as the hospital's other satisfaction survey. The difference is that with the cards, patients give immediate feedback. "The patient can then 'connect' the process to what they are rating," says Sciarabba.
The department was able to zero in on the response for "waiting time in registration." Ninety percent of patients who received cards immediately at registration rated performance for this measure as "very good." "These registration wait time scores were shared with leaders to communicate how successful patient access was in minimizing wait times specific to registration," says Sciarabba.
However, the survey results did not reflect this positive finding. In comparing the results, many patients were in fact rating their overall wait time. They included, for example, the time they spent waiting in the lobby for a diagnostic test, even after registration was completed.
To address this, a twofold solution was needed. Registration needed to communicate more clearly with the patient, and ancillary areas had to find ways to consistently improve patient wait times.
A "Code Service" page is used for service recovery.
This communication strategy is used when service recovery issues are anticipated. This may involve extended wait times, personal issues, equipment failure, operational errors, or patient complaints.
A Code Service is issued by patient access when action or follow-up is requested from one unit to another. Patient access can give a "heads up" to clinicians when patients have special needs of some kind. For instance, a patient may appear very anxious about not knowing what to expect from a diagnostic test.
"If patient access knows this up front, they can send a page to ancillary clinicians indicating the patient's disposition," says Sciarabba. "Once the ancillary department receives this, they can be prepared to take the additional time with the patient to decrease their anxiety from the initial point of contact." The text page might read: "Code Service, Mr. Smith, CT Abdomen & Pelvis, Patient is upset about condition and has many questions."
The Code Service page can alert management that an intervention is needed. "Patients that arrive without required physician orders are a constant challenge for patient access associates," says Sciarabba.
In this case, a Code Service text page can be sent to a manager reading, "Code Service, Mrs. Jones, needs X-ray, no order present and cannot reach physician office, need manager to speak with patient." A manager can then present to the area right away and speak with the patient immediately to provide service recovery.
Lastly, a Code Service page can be sent when patient access needs additional help due to a sudden surge in volume. That message might read, "Code Service, outpatient registration, 10 patients waiting to register for over 10 minutes, need help."
"Sending the Code Service page only takes a minute or two, but it can have a positive impact on the patient experience," says Sciarabba. "It improves communication between departments, ensures an effective handoff, and informs management when intervention is needed."
Implement regular leadership rounding on employees and patients.
A concierge position was created and integrated into the patient access department. This person rounds in waiting areas and directs patients appropriately.
"Ultimately, patient access must create a number of goals focused on patient satisfaction that personalize service to the patient," says Sciarabba. He says that the two key drivers to success are tracking and trending results consistently and integrating patient satisfaction goals into individual staff performance improvement plans.
"Patient access must be able to tell their story, to show their effort and share their data with department heads and senior leaders," says Sciarabba. "Improving patient satisfaction is difficult, but can be achieved one patient at a time."
Catherine M. Pallozzi, CHAM, CCS, director of patient access at Albany (NY) Medical Center Hospital, says the department previously used Press-Ganey surveys to gauge satisfaction, but she found that "it was very difficult to zero in our registration. Quite often after reviewing a concern, it was found that the wait time was not registration, but it was the service department."
When measuring satisfaction, Pallozzi says that the greatest challenge is focusing in on the brief moment the patient is with the patient access staff member.
"Patients do not know, nor should they need to know, that this facet of their visit is patient access, versus this aspect that is another department," says Pallozzi. "The best customer service experience is that when the patient states the experience was excellent from the first encounter with staff to the last."
One way to gauge the overall level of satisfaction is by the number of complaints you receive. "Complaints are always an opportunity to improve your service," Pallozzi says. "When I assumed responsibility of registration, we had a significant number of complaints stemming from wait times. That was what the leadership team focused their efforts on. We now average two service complaints a year."
Use data to make changes
Satisfaction scores and patient comments, whether good or bad, are posted in work areas for access staff to see at Emory University Hospital Midtown in Atlanta. "We review this data with our staff. Collectively, we brainstorm to develop ways to improve satisfaction," says Elease Brown, assistant director of patient financial services. "We look at wait times, courtesy whatever the issue is."
Everyone in the facility has access to these patient satisfaction scores. "We have even shared our action plans for improving scores, or maintaining good ones, with our senior leaders," says Brown.
One of the primary concerns identified by patients involved waits and delays. "We've always monitored our wait times in registration. While they appeared to be good to us, some patients felt they were not," says Brown. "We reviewed and enhanced a few of our processes, particularly those related to urgent admissions."
Staff now ensure that non-scheduled, same-day admissions are pre-registered prior to arrival. "We work with physicians' offices and transferring facilities to obtain as much information as possible prior to the patient's arrival," says Brown.
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